Provider Demographics
NPI:1518012723
Name:SAMOJEDNY, DOUGLAS ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:SAMOJEDNY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48585 FULLER RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2926
Mailing Address - Country:US
Mailing Address - Phone:586-228-4590
Mailing Address - Fax:586-228-4595
Practice Address - Street 1:43750 GARFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1135
Practice Address - Country:US
Practice Address - Phone:586-228-4590
Practice Address - Fax:586-228-4595
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist